21 research outputs found
Violência contra a mulher: uma relação entre dimensões subjetivas e a produção de informação.
The violence against women is considered a social issue and affects the lives of millions of women in their different areas of acting. An important mechanism to identify and diagnose incidents related to this phenomenon are the information and communication systems in the public sector because allow the mapping of
cases, the construction of indicators and an idea of the magnitude of the problem, allowing therefore , building more effective initiatives related to its combat. The point to be emphasized is about data produced and inserted in these systems, keeping in mind the influence of subjective dimensions derived values, beliefs, meanings and meanings attributed to violence against women. Through a literature review and documentary on the subject, the analysis refers to the inclusion of data in the Sistema de Informações de Agravos de Notificação (SINAN), the Ministry of Health. It is believed that values established culturally in society are reflected in the information produced and higher level, the existence of underreporting, establishing itself as one of the negative aspects related to data entry into the system and to combat with violence against women. It is understood that these facts refer to a historical and cultural vision marked by evaluative concepts regarding hierarchical gender patterns impacting on the procedures of the systems and commitment of professionals with the purposes established for their services
Diretriz da Sociedade Brasileira de Cardiologia sobre Diagnóstico e Tratamento de Pacientes com Cardiomiopatia da Doença de Chagas
This guideline aimed to update the concepts and formulate the standards of conduct and scientific evidence that support them, regarding the diagnosis and treatment of the Cardiomyopathy of Chagas disease, with special emphasis on the rationality base that supported it.
Chagas disease in the 21st century maintains an epidemiological pattern of endemicity in 21 Latin American countries. Researchers and managers from endemic and non-endemic countries point to the need to adopt comprehensive public health policies to effectively control the interhuman transmission of T. cruzi infection, and to obtain an optimized level of care for already infected individuals, focusing on diagnostic and therapeutic opportunistic opportunities.
Pathogenic and pathophysiological mechanisms of the Cardiomyopathy of Chagas disease were revisited after in-depth updating and the notion that necrosis and fibrosis are stimulated by tissue parasitic persistence and adverse immune reaction, as fundamental mechanisms, assisted by autonomic and microvascular disorders, was well established. Some of them have recently formed potential targets of therapies.
The natural history of the acute and chronic phases was reviewed, with enhancement for oral transmission, indeterminate form and chronic syndromes. Recent meta-analyses of observational studies have estimated the risk of evolution from acute and indeterminate forms and mortality after chronic cardiomyopathy. Therapeutic approaches applicable to individuals with Indeterminate form of Chagas disease were specifically addressed. All methods to detect structural and/or functional alterations with various cardiac imaging techniques were also reviewed, with recommendations for use in various clinical scenarios. Mortality risk stratification based on the Rassi score, with recent studies of its application, was complemented by methods that detect myocardial fibrosis.
The current methodology for etiological diagnosis and the consequent implications of trypanonomic treatment deserved a comprehensive and in-depth approach. Also the treatment of patients at risk or with heart failure, arrhythmias and thromboembolic events, based on pharmacological and complementary resources, received special attention. Additional chapters supported the conducts applicable to several special contexts, including t. cruzi/HIV co-infection, risk during surgeries, in pregnant women, in the reactivation of infection after heart transplantation, and others.
Finally, two chapters of great social significance, addressing the structuring of specialized services to care for individuals with the Cardiomyopathy of Chagas disease, and reviewing the concepts of severe heart disease and its medical-labor implications completed this guideline.Esta diretriz teve como objetivo principal atualizar os conceitos e formular as normas de conduta e evidĂŞncias cientĂficas que as suportam, quanto ao diagnĂłstico e tratamento da CDC, com especial ĂŞnfase na base de racionalidade que a embasou.
A DC no sĂ©culo XXI mantĂ©m padrĂŁo epidemiolĂłgico de endemicidade em 21 paĂses da AmĂ©rica Latina. Investigadores e gestores de paĂses endĂŞmicos e nĂŁo endĂŞmicos indigitam a necessidade de se adotarem polĂticas abrangentes, de saĂşde pĂşblica, para controle eficaz da transmissĂŁo inter-humanos da infecção pelo T. cruzi, e obter-se nĂvel otimizado de atendimento aos indivĂduos já infectados, com foco em oportunização diagnĂłstica e terapĂŞutica.
Mecanismos patogĂŞnicos e fisiopatolĂłgicos da CDC foram revisitados apĂłs atualização aprofundada e ficou bem consolidada a noção de que necrose e fibrose sejam estimuladas pela persistĂŞncia parasitária tissular e reação imune adversa, como mecanismos fundamentais, coadjuvados por distĂşrbios autonĂ´micos e microvasculares. Alguns deles recentemente constituĂram alvos potenciais de terapĂŞuticas.
A histĂłria natural das fases aguda e crĂ´nica foi revista, com realce para a transmissĂŁo oral, a forma indeterminada e as sĂndromes crĂ´nicas. Metanálises recentes de estudos observacionais estimaram o risco de evolução a partir das formas aguda e indeterminada e de mortalidade apĂłs instalação da cardiomiopatia crĂ´nica. Condutas terapĂŞuticas aplicáveis aos indivĂduos com a FIDC foram abordadas especificamente. Todos os mĂ©todos para detectar alterações estruturais e/ou funcionais com variadas tĂ©cnicas de imageamento cardĂaco tambĂ©m foram revisados, com recomendações de uso nos vários cenários clĂnicos. Estratificação de risco de mortalidade fundamentada no escore de Rassi, com estudos recentes de sua aplicação, foi complementada por mĂ©todos que detectam fibrose miocárdica.
A metodologia atual para diagnĂłstico etiolĂłgico e as consequentes implicações do tratamento tripanossomicida mereceram enfoque abrangente e aprofundado. TambĂ©m o tratamento de pacientes em risco ou com insuficiĂŞncia cardĂaca, arritmias e eventos tromboembĂłlicos, baseado em recursos farmacolĂłgicos e complementares, recebeu especial atenção. CapĂtulos suplementares subsidiaram as condutas aplicáveis a diversos contextos especiais, entre eles o da co-infecção por T. cruzi/HIV, risco durante cirurgias, em grávidas, na reativação da infecção apĂłs transplante cardĂacos, e outros.
Por fim, dois capĂtulos de grande significado social, abordando a estruturação de serviços especializados para atendimento aos indivĂduos com a CDC, e revisando os conceitos de cardiopatia grave e suas implicações mĂ©dico-trabalhistas completaram esta diretriz. 
Pervasive gaps in Amazonian ecological research
Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4
While the increasing availability of global databases on ecological communities has advanced our knowledge
of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In
the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of
Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus
crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced
environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian
Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by
2050. This means that unless we take immediate action, we will not be able to establish their current status,
much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio
Pervasive gaps in Amazonian ecological research
Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost
Organogênese in vitro a partir de diferentes regiões do epicótilo de Citrus sp Citrus sp. organogenesis in vitro from different epicotyl's regions
O estabelecimento de protocolos para regeneração de plantas in vitro Ă© essencial para o uso de tĂ©cnicas de transformação genĂ©tica no melhoramento de citros. Visando Ă obtenção de um protocolo eficiente de regeneração in vitro para laranja-azeda (Citrus aurantium), laranjas 'Natal' e 'PĂŞra' (C. sinensis), limĂŁo 'Volkameriano' (C. volkameriana) e citrange 'Carrizo' (Poncirus trifoliata x C. sinensis), avaliou-se a resposta morfogĂŞnica de diferentes regiões do epicĂłtilo (basal, mediana e apical) em relação a distância do nĂł cotiledonar, na presença (1,0 mg/L-1) ou ausĂŞncia de 6-BAP, em meio de cultura MT. ApĂłs 60 dias, avaliaram-se a porcentagem de explantes responsivos e o nĂşmero de gemas adventĂcias por explante. A resposta morfogĂŞnica em função da regiĂŁo do epicĂłtilo e da presença ou ausĂŞncia da citocinina (6-BAP) foi influenciada pelo genĂłtipo. A presença de 6-BAP no meio de cultura promoveu aumento na porcentagem de explantes responsivos para citrange 'Carrizo'. A suplementação do meio de cultura com a citocinina 6-BAP proporcionou aumento no nĂşmero de brotos por explante para citrange 'Carrizo', laranja 'Natal' e limĂŁo 'Volkameriano'.<br>The establishment of an in vitro plant regeneration protocol is essential for the use of genetic transformation techniques in Citrus breeding programs. Aiming to obtain an efficient protocol of in vitro regeneration for sour orange (Citrus aurantium), sweet oranges 'Natal' and 'PĂŞra' (C. sinensis), 'Volkamer' lemon (C. volkameriana) and 'Carrizo' citrange (Poncirus trifoliata x C. sinensis), the morphogenetic response was evaluated for different epicotyl's regions (basal, medium and apical) regarding the distance from the cotyledonary node, in presence (1,0 mg/L-1) or absence of 6-BAP in MT medium. After 60 days, the percentage of responsive explants and number of shoots per explants were evaluated. The morphogenetic response related to the epicotyl's region and the presence or absence of the cytokinin (6-BAP) were genotype influenced. The presence of 6-BAP in the culture medium showed a greater percentage of responsive explants for 'Carrizo' citrange. The addition of 6-BAP to the culture medium provided an increase in the number of shoots per explants for 'Carrizo' citrange, 'Natal' sweet orange and 'Volkamer' lemon
Applying the maternal near miss approach for the evaluation of quality of obstetric care : a worked example from a multicenter surveillance study
Objective. To assess quality of care of women with severe maternal morbidity and to identify associated factors. Method. This is a national multicenter cross-sectional study performing surveillance for severe maternal morbidity, using the World Health Organization criteria. The expected number of maternal deaths was calculated with the maternal severity index (MSI) based on the severity of complication, and the standardized mortality ratio (SMR) for each center was estimated. Analyses on the adequacy of care were performed. Results. 17 hospitals were classified as providing adequate and 10 as nonadequate care. Besides almost twofold increase inmaternalmortality ratio, themain factors associated with nonadequate performance were geographic difficulty in accessing health services ( < 0.001), delays related to quality of medical care ( = 0.012), absence of blood derivatives ( = 0.013), difficulties of communication between health services ( = 0.004), and any delay during thewhole process ( = 0.039). Conclusions. This is an example of how evaluation of the performance of health services is possible, using a benchmarking tool specific to Obstetrics. In this study the MSI was a useful tool for identifying differences in maternal mortality ratios and factors associated with nonadequate performance of care
Applying the maternal near miss approach for the evaluation of quality of obstetric care : a worked example from a multicenter surveillance study
Objective. To assess quality of care of women with severe maternal morbidity and to identify associated factors. Method. This is a national multicenter cross-sectional study performing surveillance for severe maternal morbidity, using the World Health Organization criteria. The expected number of maternal deaths was calculated with the maternal severity index (MSI) based on the severity of complication, and the standardized mortality ratio (SMR) for each center was estimated. Analyses on the adequacy of care were performed. Results. 17 hospitals were classified as providing adequate and 10 as nonadequate care. Besides almost twofold increase inmaternalmortality ratio, themain factors associated with nonadequate performance were geographic difficulty in accessing health services ( < 0.001), delays related to quality of medical care ( = 0.012), absence of blood derivatives ( = 0.013), difficulties of communication between health services ( = 0.004), and any delay during thewhole process ( = 0.039). Conclusions. This is an example of how evaluation of the performance of health services is possible, using a benchmarking tool specific to Obstetrics. In this study the MSI was a useful tool for identifying differences in maternal mortality ratios and factors associated with nonadequate performance of care
Diretriz da SBC sobre Diagnóstico e Tratamento de Pacientes com Cardiomiopatia da Doença de Chagas – 2023
Note: These guidelines are for information purposes and should not replace the clinical judgment of a physician, who must ultimately determine the appropriate treatment for each patient